Comp Clin Pathol (2015) 24:1253–1255 DOI 10.1007/s00580-015-2084-1
BRIEF COMMUNICATION
Pyothorax associated with Salmonella and Pseudomonas spp. infection in a FIV-positive cat Baharak Akhtardanesh & Samira Hosseini Hooshyar & Zeinab Abiri & Mahyar Hejazi
Received: 26 November 2014 / Accepted: 12 February 2015 / Published online: 25 February 2015 # Springer-Verlag London 2015
Abstract Pyothorax associated with Salmonella and Pseudomonas spp. infection in a 2-year-old female domestic shorthair cat is described in this clinical report. The cat had cachexia with a past history of diarrhea and severe dyspnea. Retrovirus testing by using rapid polymerase chain reaction (PCR) showed that the animal was infected with feline immunodeficiency virus (FIV). Radiography showed severe pleural effusion. On postmortem examination, pyothorax with extensive deposition of fibrin on pleural membranes and tracheobronchial tree and pulmonary congestion were seen. Salmonella and Pseudomonas spp. was isolated from drained effusion. It seems that immunodeficiency caused by FIV infection was the main predisposing factor for spreading of Salmonella and Pseudomonas spp. from gastrointestinal tract to thoracic cavity by hematogenous route in this case.
Keywords Cat . FIV . Pseudomonas . Salmonella . Pyothorax
B. Akhtardanesh (*) : M. Hejazi Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, P.O.Box 76169133, Kerman, Iran e-mail:
[email protected] S. H. Hooshyar Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Z. Abiri Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
Introduction Pyothorax which is characterized with the accumulation of purulent exudates in the pleural space is considered as a common life-threatening emergency in small animal practice, whereas there are no data on the incidence of disease in the cat (Barrs and Beatty 2009; Miller 2000). This disease most commonly occurs in cats with a mean age of 4–6 years with no breed or gender predisposition (Davies and Forrester 1996; Walker et al. 2000; Demetriou et al. 2002; Waddell et al. 2002; Barrs et al. 2005). Possible routes of infection include extension from an adjacent structure, direct inoculation or hematogenous or lymphatic spread from a distant site (Barrs and Beatty 2009). Bacterial isolates from the majority of cases of pyothorax are polymicrobial and similar to the normal feline oropharyngeal flora (Love et al. 2000). Isolates include obligate and facultative anaerobic bacteria; Bacteroidaceae (Bacteroides spp., Porphyromonas spp., Prevotella spp.), Fusobacterium spp., Peptostreptococcus spp., Clostridium spp., Actinomyces spp., Eubacterium spp., Propionibacterium spp., Filifactorvillosus, Pasteurella multocida, Streptococcus spp., and Mycoplasma spp. (Thompson et al. 1992; Walker et al. 2000; Gulbahar and Gurturk 2002; Wegner and Pablo 2006). Less than 20 % of cases of feline pyothorax are caused by infectious agents other than oropharyngeal flora including Staphylococcus spp., Rhodococcus equi, Nocardia spp., enteric Gram-negative organisms (Escherichia coli, Salmonella spp., Klebsiella spp., Proteus spp.), non-enteric Gram-negative organisms (Pseudomonas spp.) and protozoa (Toxoplasma gondii) (Gruffydd-Jones and Flecknell 1978; Barrs et al. 1999, 2005; Walker et al. 2000; Demetriou et al. 2002; Anfray et al. 2005). Fungal causes of feline pyothorax are rare and include Cryptococcus spp., Candida albicans, and Blastomyces dermatitidis (McCaw et al. 1984; Barrs et al. 2005). However, isolation of Salmonellae spp. from feline
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pleural effusion is a very rare entity which is described in the present clinical report.
Case presentation A 2-year-old female cat was admitted to a small animal hospital of Shahid Bahonar University (Kerman, Iran) with a 1-month history of diarrhea, anorexia, weight loss, and recent history of severe dyspnea. In clinical examination, pale mucous membranes, military dermatitis and several skin wounds on the muzzle area and muffled thoracic sounds were noted. Radiography showed severe plural effusion. Thoracocentesis was done, and drained straw-colored gelatinous fluid submitted for bacteriological and cytological examinations.
Laboratory examination Blood sample was taken for hematological and biochemical evaluation. Complete blood count showed leukocytosis (32,000/μl) with a degenerative left shift neutropenia and toxic changes in neutrophils. In biochemical analysis, hyperglobulinemia (5.4 g/dl) and elevated alkaline phosphatase (210 IU/l) level were detected. Urinalysis showed normal findings. In cytological examination, the effusion was exudate with elevated protein level (5.5 g/dl). Proliferation of lymphocytes, degenerative neutrophils, and reactive monocytes among with presence of bacilli and cocobacill forms of bacteria was noted (Fig. 1).
Fig. 1 Proliferation of lymphocytes and degenerative neutrophils with presence of intracellular and extracelluar bacills and cocobacills in plural effusion
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Bacteriological examination The effusion was cultured on blood agar and MacConkey agar and incubated aerobically and anaerobically at 37 °C with CO2 at a concentration of 5–10 % for 24 h. Observed colonies were 2–3 mm in diameter, pale, and non-lactose fermenting on MacConkey agar and grey, round, and non-hemolytic on blood agar. Microscopic examination showed Gram-negative medium-sized rods bacteria from both media. According to standard biochemical test, suspected colonies were defined as Salmonella spp. and Pseudomonas spp.
Retrovirus testing The cat was tested for infection status with respect to feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) by using rapid polymerase chain reaction (PCR) kits (VITEK™ Company, South Korea). The cat was considered FIV positive based to detection of 553-bp fragments which is specific for virus.
Pathological examination The animal died because of respiratory decompensation before thoracostomy tube was inserted for antibiotic therapy. On postmortem examination, pyothorax with extensive deposition of fibrin on pleural membranes and tracheobronchial tree and pulmonary congestion were seen (Fig. 2). No significant abnormality was found in other organs. Based on animal medical history and immunocompromised status, it seems that hematogenous route was the main route for spreading of Salmonella spp. and Pseudomonas from gastrointestinal tract to thoracic cavity in this case.
Fig. 2 Pyothorax with extensive deposition of fibrin on pleural membranes
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Discussion Salmonellosis in humans and domestic animals remains a serious, worldwide problem, with outcomes that range from asymptomatic carriage to the more serious systemic infection that may result in high mortality (Gyles et al. 2010). Feline salmonellosis could occur in different clinical forms including gastroenteritis, bacteremia/endotoxemia, pyrexic episodes accompanied by vomiting, localized infection in extraintestinal organs such as conjunctivitis, abortion, stillbirths, and fading kittens (Chandler et al. 2004). Salmonellosis in cats has been associated with a wide variety of serotypes, most frequently Salmonella typhimurium (Philbey et al. 2008). There have been several reports of isolation of Salmonella. enteritidis from stray cats and catteries, and it is reported as a major cause of bacteremia in critically ill cats (Fox and Beaucage 1979; Dow et al. 1989). In humans and dogs, salmonellosis is associated with immunosuppression caused by neoplasia and chemotherapy, hospitalization, and oral antibiotic therapy. Pyothorax associated with Salmonella spp. infection is a very rare entity in feline medicine, but S. typhimurium has been isolated from pleural effusion in a retrospective study of 27 cases of feline pyothorax in Australia (Barrs et al. 2005). Occurrence of salmonellosis associated with lymphoma, lymphosarcoma, and Aelurostrongylus abstrusus infection in cats has been reported previously (Hohenhaus et al. 1990; Bhaiyat et al. 2009; Barrs et al. 1999). Immunosuppression related to FIV infection was reported as a predisposing factor for pulmonary cryptococcosis and Capillaria aerophila infection in a 12-year-old cat (Barrs et al. 2000). However, association between FIV infection and pyothorax, either as a predisposing event or a prognostic indicator was not determined yet (Barrs and Beatty 2009). Past medical history and leukogram of presented case showed that immunosuppression caused by FIV infection was the main predisposing factor for hematogenous spread of Salmonella and Pseudomonas and occurrence of pyothorax. Prospective studies will provide useful information on any association between retroviruses infection and pyothorax caused by unusual pathogens like as Salmonella and Pseudomonas spp. for feline practitioners. Conflict of interest None of the authors of this paper has a financial or personal relationship with other people or organizations that could inappropriately influence or bias the content of the paper.
References Anfray P, Bonetti C, Fabbrini F, Magnino S, Mancianti F, Abramo F (2005) Feline cutaneous toxoplasmosis: a case report. Vet Dermatol 16:131–136
1255 Barrs VR, Beatty JA (2009) Feline pyothorax—new insights into an old problem: part 1. Aetiopathogenesis and diagnostic investigation. Vet J 179:163–170 Barrs VR, Swinney GR, Martin P, Nicoll RG (1999) Concurrent Aelurostrongylus abstrusus infection and salmonellosis in a kitten. Aust Vet J 77:229–232 Barrs VR, Martin P, Beatty JA et al (2000) Pulmonary cryptococcosis and Capillaria aerophila infection in an FIV-positive cat. Aust Vet J 78: 154–158 Barrs VR, Martin P, Allan GS et al (2005) Feline pyothorax: a retrospective study 27 cases in Australia. JFMS 7:211–222 Bhaiyat MI, Hariharan H, Chikweto A, Brathwaite-Sylvester E, Burnett PJA, Matthew V, Oliveira S, Johnson C (2009) Concurrent lymphosarcoma and Salmonella enteritidis infection in a cat: a case report. Vet Med-Czech 54:451–454 Chandler EA, Gaskell CJ, Gaskell RM (2004) Feline medicine and therapeutics, 3rd edn. Blackwell, Oxford, pp 397–435 Davies C, Forrester SD (1996) Pleural effusion in cats: 82 cases (1987 to 1995). J Small Anim Pract 37:217–224 Demetriou JL, Foale RD, Ladlow J, McGrotty Y, Faulkner J, Kirby BM (2002) Canine and feline pyothorax: a retrospective study of 50 cases in the UK and Ireland. J Small Anim Pract 43:388–394 Dow SW, Curtis CR, Jones RL, Wingfield WE (1989) Bacterial culture of blood from critically ill dogs and cats: 100 cases (1985–1987). J Am Vet Med Assoc 195:113–117 Fox JG, Beaucage CM (1979) The incidence of Salmonella in randomsource cats purchased for use in research. J Infect Dis 139:362–365 Gruffydd-Jones TJ, Flecknell PA (1978) The prognosis and treatment related to the gross appearance and laboratory characteristics of pathological thoracic fluids in the cat. J Small Anim Pract 19:315–328 Gulbahar MY, Gurturk K (2002) Pyothorax associated with a Mycoplasma sp. and Arcanobacterium pyogenes in a kitten. Aust Vet J 80:344–345 Gyles CL, Prescott JF, Songer JG, Thoen CO (2010) Pathogenesis of bacterial infections in animals, 4th edn. Blackwell, Oxford, pp 231–257 Hohenhaus AE, Rosenberg MP, Moroff SD (1990) Concurrent lymphoma and salmonellosis in a cat. Can J Vet 31:38–40 Love DN, Malik R, Norris JM (2000) Bacteriological warfare amongst cats: what have we learned about cat bite infections? Vet Microbiol 74:179–193 McCaw D, Franklin R, Fales W et al (1984) Pyothorax caused by Candida albicans in a cat. J Am Vet Med Assoc 185:311–312 Miller JI (2000) The history of surgery of empyema, thoracoplasty, Eloesser flap, and muscle flap transposition. Chest Surg Clin N Am 10:45–53 Philbey AW, Mather HA, Taylor DJ et al (2008) Isolation of avian strains of Salmonella enterica serovar Typhimurium from cats with enteric disease in the United Kingdom. Vet Rec 162:120– 122 Thompson JC, Gartrell BM, Butler S et al (1992) Successful treatment of feline pyothorax associated with an Actinomyces species and Bacteroides melanogenicus. NZ Vet J 40:73–75 Waddell LS, Brady CA, Drobatz KJ (2002) Risk factors, prognostic indicators, and outcome of pyothorax in cats: 80 cases (1986–1999). J Am Vet Med Assoc 221:819–824 Walker AL, Jang SS, Hirsch DC (2000) Bacteria associated with pyothorax of dogs and cats: 98 cases (1989–1998). J Am Vet Med Assoc 216:359–363 Wegner K, Pablo L (2006) Anesthesia case of the month. J Am Vet Med Assoc 228:850–853
